March 10-11, 2024

Welcome

Back!

What 1 exhibitor did you visit that you were impressed with?

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LTC at Home

Ronna Hauser, PharmD

Senior Vice President, Policy and Pharmacy Affairs

National Community Pharmacists Association

Pharmacy Profit Summit 2024

NCPA LTC DIVISION

Pharmacy by the Numbers

51% of independent community pharmacies serve long-term care facilities

Data source: 2023 NCPA Digest

The 51% report serving an average of

Data source: 2023 NCPA Digest

44 beds

Average beds by facility

Skilled Nursing Facilities

Assisted Living

Residential Facilities

Correctional Facilities

Data source: 2023 NCPA Digest

NCPA LTC DIVISION

Resources

Agreement Templates

FAQs

LTC Business Webinar Series

Starting an LTC Pharmacy step-by-step guides

Senior-Friendly Pharmacy Services info

Technology Corner

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LTC Division Resources

LTC Live Seminars

Business of LTC April 19-20, 2024 in Alexandria VA

NCPA LTC Division

Legislative Priorities

Grassroots Call to Action

1. Part D Reasonable and Relevant Contract Terms

S. 3430, Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (unanimously passed the Senate Finance Committee)

Includes the No PBMs Act, which requires CMS to define reasonable and relevant contract terms in Medicare

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Grassroots Call to Action

2. Medicaid Managed Care

S. 2973, the Modernizing and Ensuring PBM Accountability (MEPA) Act (passed 26-1 out of the Senate Finance Committee)/H.R. 5378, the Lower Costs, More Transparency Act (passed the House of Representatives on an overwhelming bipartisan vote of 320-71)

Bans spread pricing in Medicaid managed care by requiring a fair and transparent reimbursement to pharmacies and saves over $1 billion!

Grassroots Call to Action

3. PBM Transparency

S. 127, the Pharmacy Benefit Manager Transparency Act (passed 18-9 out of the Senate Commerce Committee)

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Inflation Reduction Act

• Vaccines – Part D, Medicaid, CHIP
• Insulin – Part D and MA

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For Part D:

• Coinsurance for catastrophic coverage eliminated
• Premium increases capped

For Part D:

• Annual out-of-pocket cap
• Optional “smoothing” of patient cost-sharing

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• Medicare Part D drug price negotiation

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LTC Pharmacy at Home Update

CMS Guidance: LTC Pharmacy Performance & Service Criteria

Comprehensive Inventory & Inventory Capacity

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Pharmacy Operations & Prescription Orders

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Special Packaging

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IV Medications

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Compounding & Alternative Forms of Drug Composition

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Pharmacist On-Call

Service

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Delivery Service

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Emergency Boxes

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Emergency Logbooks

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Miscellaneous Reports,

Forms and Prescription Ordering Supplies

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LTC Pharmacy @ Home

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*Overview of Medical at Home Pharmacy Services. National Community Pharmacists Association. June 2019.

“A collaborative effort by long-term care pharmacies to provide skilled services to patients aging in their home, focusing on patients’ healthcare needs to ensure coordinated high levels of care.”

LTC @ Home

NCPA LTC Division Top Priority

Began advocating to CMS leadership in 2019

NCPA asked CMS to recognize medical at home pharmacy services regardless of where the patient resides…

LTC @ Home

…Which they did in 2021!

What is CMS Doing to address LTC at Home?

The second example, most relevant to this discussion, states that costs associated with specialized services, such as special packaging and delivery for “residents of non-LTC facilities (e.g., assisted living facilities (ALFs) and other forms of congregate residential settings) with the same level of care need as residents of LTC facilities”, would be allowable dispensing fee costs. This is because it is reasonable to assume the typical enrollee residing in a non-LTC facility setting who meets the same level of care need as a beneficiary in an LTC facility would require the provision of dispensing related services such as unit-dose packaging and home delivery that are provided by LTC pharmacies to the residents of LTC facilities.

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While our existing guidance provides only ALFs and other congregate residential settings as examples where costs associated with specialized services, such as special packaging and delivery, are reasonable pharmacy costs for the typical enrollee that meets the same level of care need as an enrollee in a long-term care facility, the same logic holds for enrollees residing in their homes with the same level of care needs. Therefore, CMS clarifies that such additional costs are reasonable pharmacy costs for these enrollees residing in their homes. Part D sponsors continue to have the flexibility to establish their own policies for determining which enrollees residing in non-institutionalized settings, including their own homes, meet this threshold.

LTC Pharmacy at Home Criteria – 2 ADL support

Basic ADLs

Instrumental ADLs

Additional Patient Qualifiers

• Taking multiple medications – Minimum of 6
• Multiple chronic conditions- Minimum of 3
• Recent SNF stay, Hospitalization, ER Visit or receiving home Health services/support from agency
• Needs assistance Coordinating Care, including pharmacy care
• Limited Mobility that makes leaving the home difficult without assistance

How do I find LTC at Home Patients?

• Identify total potential opportunity
• Search PMS for: Rx Identifier, total amount paid, BIN, PCN, Rx Group,
• Assess based on BIN:PCN – Medicare Part D plans that support LTC@Home in some way
• Assume 15% of RX’s will qualify (this is conservative based on results) and an 8% DIR fee
• Is this number worth pursuing?

How do I find LTC at Home Patients?

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• Additional potential Identifiers
• Compliance packaging patients
• Medication Synch patients
• Patients known to have Home Care

LTC Pharmacy at Home – Marketplace Plan Structures

• May recognize LTC Pharmacy at Home the same as SNF
• Review dispensing fees and molecule margin that may be different
• No DIR fees

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• Might recognize LTC Pharmacy at Home and paid at higher than retail rate
• Review dispensing fees and/or molecule margin that may be impacted
• No DIR fees

LTC Pharmacy at Home – Marketplace Plan Structures

• Not formally recognize LTC Pharmacy at home at all
• Review for any possible molecule reimbursement adjustments at POS
• Verify no DIR based on LTC service level

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• No LTC Pharmacy at Home benefit

Refer to your LTC GPO for specifics on plan structures and what might be available to you.

LTC Pharmacy at Home – Financial Examples

• Assumptions – 100 prescriptions
• 10 Rx per patient
• 10 patients
• Average retail community reimbursement ($59.67/Rx – NCPA Digest)
• DIR assumed to be 10% (average 8-12% per Rx)

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• Total reimbursement of $5967 if no increased dispense fee
• DIR Fee avoidance of $597
• Potential increased reimbursement of $250-$400

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• $597-$997 average new and retained revenue for Pharmacy

Potential Brand Example DIR @ POS

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Brand Drug example

WAC = $320 LTC Contract Cost = $310.40 (3% discount)

AWP = $384 Wholesaler COGs of 4%

Potential Brand Example DIR @ POS

Example Retail Contract

• AWP-23% = $295.68
• Acquisition cost = $307.20
• Gross Margin of -$11.52 (no margin at AWP-20%)

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Example LTC Pharmacy at Home contract

• AWP-13% + Dispense fee = 337.83
• Acquisition cost of $307.20 ($297.98 if on contract)
• Gross Margin of $30.63 ($39.85 on contract)

Patient Qualification Documentation

• PBMs have no defined documentation currently
• Single page document per patient retained in patient profile
• Patient demographics – name, address, etc
• LTC Services provided by the pharmacy
• Activities of Daily Living supported for patient
• List of other criteria – 3 or more chronic disease states, 6 or more maintenance medications, inability to leave or difficulty leaving home on their own
• Provider, caregiver, or pharmacist attestation/signature – should be person assessing the eligibility of the patient

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Requirements & Clinical Best Practices

Must meet minimum criteria for LTC pharmacy

• Specialized (Compliance) Packaging
• Delivery
• 24/7 pharmacist access

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Requirements & Clinical Best Practices

Additional services recommended

• Monthly medication regimen reviews
• Determine if other medical services can be offered in your state such as remote patient monitoring, or chronic care management
• Medication synchronization
• Medication reconciliation
• Coordination of care with prescribers and caregivers and patient
• Assistance with other patient needs – like food, transportation

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Identify 10 patients that qualify for Medical at Home

• Identify 10 patients that qualify for LTC Pharmacy at home in your PMS.
• Get a second NCPDP & NPI number and enroll in an LTC PSAO to bill LTC services now.
• Join the NCPA LTC Division for an attestation form (and other resources).

Accomplishments

• Formation of the Alliance for LTC Pharmacy @ Home with ASCP and SCPC
• Met with White House, HHS, CMS, and Congressional staff to discuss LTC at Home
• Provided CMS with legal analysis supporting a CMS regulatory change

More to come!

LTC @ Home

The Alliance for LTC Pharmacy @ Home

https://www.pharmacyathome.org/

• Join NCPA LTC
• Join LTC Network (get paid more with no DIR fees)
• Join LTC GPO (pay less for inventory)
• Meet LTC Performance Criteria
• Compliance Packaging
• 24/7 On Call
• Delivery
• Plus More
• Qualify patients who meet criteria with attestation
• Grow your LTC Pharmacy business!

To Do List To Get Started

Thank You

Time Management & Productivity

PRODUCTIVITY VS TIME MANAGEMENT

• In the personal sense, productivity is the ability to get things done in an efficient and consistent manner.
• Time management is the set of guidelines or theories used to be more productive.

GSD are my favorite 3 letters!

Focus on being productive instead of busy.

Every minute you’re not doing the work...�you’re not doing the work!

• Energy Tracker
• Lisa’s Tips
• Expert Task Analysis
• Delegation
• Take Care of Yourself

DEVELOP A PERSONAL PLAN

Set Yourself Up For Success

Understanding Yourself

• Are you a morning, afternoon or late person?
• No right or wrong.
• Better off not fighting your natural internal energy clock.
• If you don’t know, then track your energy/focus for a few days
• Do the ‘hard’ work when you are at your peak energy

WHEN ARE YOUR PRODUCTIVE?

Set Yourself Up For Success

Set Yourself Up For Success

LISA’S PRODUCTIVITY TIPS

• Use a calendar
• Live and die by your calendar
• Always obey your calendar
• Teach others to respect your calendar
• Program in reminders
• Ensure it is on your phone
• Always obey your calendar!!

• Time Blocking
• Building your calendar out for specific tasks that must be done
• Great for big tasks or projects to stay on track
• Examples: employee 1-on-1s, meetings with hired help, space for personal appointments, Lunch ☺

LISA’S PRODUCTIVITY TIPS

• Batching
• When you have quick tasks that are repetitive (i.e., emails, check Rxs, mail)
• Set blocks throughout your day or week to dedicate to just that task. This saves you time because you are not switching between tasks.
• Each time you change tasks you lose the time it takes to shift and refocus.

LISA’S PRODUCTIVITY TIPS

• Themed Days
• Create a business focus for each day
• Critical to my success when I was a dispensing RPh still
• You only work on items that fit in the day unless it is a 3-alarm fire
• Examples: Monday = Marketing, Tuesday = Team, Friday = Financial

LISA’S PRODUCTIVITY TIPS

• Brain Dump
• Our brains were not designed to be file cabinets.
• Write down everything that is floating around in your mind.
• Organize into categories: Urgent, Important, Low Priority, Ideas.
• When a new idea comes to mind write it down on one of these lists.
• Keep your mind clear of clutter!
• This is a living document that is added/subtracted/reorganized frequently.
• Find delegation opportunities in this list.

LISA’S PRODUCTIVITY TIPS

• Create A Daily To-Do List
• Put in order of priority
• No more than 1-3 must absolutely do today no matter what items
• Reward yourself for daily wins (your brain might do this automatically with dopamine hits)
• Makes the journey the goal, not just the destination

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LISA’S PRODUCTIVITY TIPS

• Tools
• Google calendar*
• Remarkable tablet*
• Calendly*
• Pen and paper
• Trello, Notion boards (Kanban)
• Virtual assistants* (shellamae@sourcingonlineservices.com)

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LISA’S PRODUCTIVITY TIPS

• Random Thoughts
• If it takes less than a minute then just do it
• Don’t rely on your brain, rely on a system
• Inbox detonation might be necessary - Inbox zero is my daily goal

LISA’S PRODUCTIVITY TIPS

• Random Thoughts Continued
• Leveraging your time is your greatest superpower for success – every 9 & 10 figure business person I know, understands this to their core
• Say NO to somethings, in order to say YES to others
• If someone can do it 80% as good as you that is “perfect”
• Have an unsubscribe time block once a month

LISA’S PRODUCTIVITY TIPS

Set Yourself Up For Success

Self Evaluation

Expert Task Analysis

LIKE & DO WELL

LIKE & DON’T DO WELL

DON’T LIKE & DO WELL

DON’T LIKE & DON’T DO WELL

EXPERT TASK ANALYSIS

• What do you need to focus on?
• What do you need to give up?
• Do this for your employees, too.
• Delegate ‘bottom row’

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It only takes me 10 minutes...

But...

It only takes me 10 minutes...

LOST TIME

• It’s just 10 mins…
• 50 mins a week
• 3.6 hours a month
• 43 hours a year
• 3 tasks
• 2.5 hours a week
• 3.23 weeks a year

DELEGATE TO WHO?

• Employees
• Outside companies
• Virtual Assistants

HOW TO DELEGATE?

• Delegation not Abdication
• Clear communication is PRIORITY
• What, how, and by when...
• Explain the priority of tasks delegated
• Start small and build trust and confidence
• Schedule regular check-ins
• Give feedback and help them get better

Take Care of Yourself

TAKE CARE OF YOURSELF

• Sleep
• Support your adrenals
• Cymbiotika – adrenal super tonic makes me super human ☺
• Go to the damn doctor!
• Hydrate
• Move & get outside
• Respect yourself
• Invest in yourself
• Turn it all off once in a while

MY LIST

• Cymbiotika Adrenal & Black Gold
• fatty15
• AMS Nitric Oxide
• Vinco Liposomal Iron
• Thyroid Warrior Iodine
• 7 Multi Magnesium Complex
• Pregnenolone
• ADK, Simply Veggies, Simply Fruit, Nutraceuticals, Probiotics – less regularly
• Monthly massages
• Facials
• Getting outside
• Time with kids
• Hiring out for household chores
• Hot magnesium baths
• Watching shows with hubby
• Reading/listening

Thank You

GETTING COMFORTABLE WITH

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UNCOMFORTABLE CONVERSATIONS

Ajay Mehra

UGO Rx

Co-Founder

OUR RESPONSIBILITIES AS OWNERS

Wellness of our Patients

Wellness of our Prescribers

Wellness of our Business

C W O

The Greatest Disservice you can do for your Patients, is to Close Your Doors

Yes or No, it is the pharmacies job to educate prescribers on formulary changes and drug coverage?

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SO LET’S GET INTO IT.

-> SCENARIOS

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-> APPROACH

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-> SCRIPTS

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PATIENT

WELLNESS

Psychology:

We want to inform them of an alternative medication option available, but what is the benefit to them?

Approach:

We are calling to check to see how the medication we dispensed is working, and to let them know of an alternative option covered by their insurance that might more effective

PATIENT

WELLNESS

Intro:

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Hi this is _______ from ______ Pharmacy. We are doing a quick wellness call to see how your medications are working out. Do you feel like they are working for you? Are you experiencing any side effects?

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Get to the point:

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We also wanted to inform you that your insurance does cover another option which is (name of new med). This medication may have potential benefits such as (list benefits… is it stronger, better absorbing, work better… etc.)

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Closing:

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We would be more than happy to reach out to your doctor for you and inform them of this alternative to see if they would like to switch therapy for you.

PRESCRIBER

EDUCATION

Psychology:

We want prescribers to write for medications that work well for patients and reimburse well for pharmacy, why should they care?

Approach:

By keeping the prescriber updated on formulary changes, we help them avoid headaches caused by PA’s & rejections, ensure patients get treatment quickly

PRESCRIBER

EDUCATION

Intro:

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Hi this is _______ from ______ Pharmacy. We currently service a number of your patients, and I’m reaching out because we have noted recent changes to insurance formularies based on the type of medications your write for your patients, and what other providers in the same space are writing and wanted to update you.

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Get to the point:

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Based on the drug classes you currently write for, we identified some new medications that are covered on your patients formularies that might be better options.

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🡪 Give an example

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Closing:

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We want to ensure we keep you and your practice updated on coverage changes we notice so that you don’t get bogged down with rejections, PA’s, and upset patients trying to get their meds. I’d love to swing by and drop of a list of a some changes.

PRESCRIBER

MARKETING

Psychology:

We want prescribers to refer their patients to our pharmacy, but what’s in it for them??

Approach:

Our pharmacy will make life easier for you, your staff, and your patients.

PRESCRIBER

MARKETING

Intro:

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Hi this is _______ from ______ Pharmacy. We service a number of prescribers and their patients in the area and I wanted to quickly introduce ourselves.

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Get to the point:

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We understand the hurdles clinics deal with on a daily basis, from the big chain pharmacies, and we focus our pharmacy on reducing those headaches for the clinics we work with.

-> List what you do differently (your USP)

** hint – state what we covered in the previous 2 slides ;)

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Closing:

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We would love to swing by and drop off some info for you and your patients.

PATIENT

TRANSFER

Psychology:

We are losing money on a medication or a patient profile, we want them to get this drug(s) from mail-order, but we need them to understand we are not refusing to serve them.

Approach:

Honesty is the best policy

PATIENT

TRANSFER

Intro:

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Hi this is _______ from ______ Pharmacy. We recently dispensed/received a prescription for you for (name of med)

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Get to the point:

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We are calling because unfortunately none of our suppliers carry this medication at an affordable price.

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Closing:

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However, we have a solution that will still get you this medication and even potentially save you money. We can transfer this prescription(s) to your insurance’s mail-order pharmacy. We will take care of everything for you and have it shipped to our pharmacy to be ready for pick up with your other medications. Would this be ok with you?

What questions do you have?

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WWW.UGORX.COM

THANK YOU!!!

PLEASE VISIT

Lunch Break!

1:00 PM – 2:30 PM